Surgery to remove the gallbladder is a serious interference with the work of the digestive system. After surgery, the patient must adhere to certain recommendations to prevent deterioration of health. If all the rules are followed, a person may well live a few more decades, lead a normal life, and carry out everyday activities. You removed the gallbladder and you want to know what the consequences might be? Then this article is for you.
Removed the gallbladder: what could be the consequences?
Gall bladder: its functions in the body
The gallbladder is a small pear-shaped organ. It does not exceed 14 cm in length (the norm is the length from 8 cm to 14 cm), only 3-5 cm in width.
Its main task is the accumulation and storage of bile, which is formed in the liver cells. It can hold up to 70 cubic centimeters of bile. Being here, the bile acquires a thicker texture, and then evacuated along the bile ducts into the intestine through the sphincter of Oddi, where it participates in the splitting of food.
The location of the gallbladder
Gall bladder function:
- Accumulative, or depositing. Here is going to all the bile produced by the liver.
- Concentration is reduced to thickening of bile.
- Evacuation. When the gallbladder contracts, pushing the contents out, it enters the duodenum through the ducts. At the same time, bile is not released continuously or at a certain frequency, but only when it is necessary for the splitting of food. If this function is impaired, the bile stagnates, thickens excessively. Over time, this leads to the formation of sand and stones.
Bile is necessary for the breakdown of food. It is also a powerful antiseptic – disinfects the intestinal contents, kills most pathogenic and excess conditionally pathogenic bacteria. It is thanks to her that a person does not get an intestinal infection every time he eats an ideally fresh or clean product.
In the duodenum, it creates an alkaline environment, which is detrimental to the larvae of most worms. If the bile is sufficiently concentrated, the function of the gallbladder is not impaired – a person can avoid the infection with worms even if they get into the intestines with food.
It is also responsible for the breakdown and absorption of fats, stimulates intestinal motility, and participates in the formation of intraarticular fluid.
Disruption of the outflow of bile, its insufficient amount leads to indigestion. Such patients often have constipation, intestinal dysbiosis, a violation of the process of assimilation of fats.
If a violation of the outflow of bile develops inflammation of the gallbladder, a precipitate appears, which eventually collects in stones. To relieve inflammation and prevent the formation of stones, cholagogue preparations are prescribed.
Indications for gallbladder removal
Cholecystectomy is a radical operation, after which a person’s life changes somewhat. Therefore, without a reason, only with the preventive purpose, this operation is not carried out. Indications for surgery are presented in the table below.
Table 1. Indications for surgery to remove the gallbladder
Is it possible to do without surgery?
Gallstone disease and other diseases may not be felt for a long time. Quite often there are situations when gallstones are detected by chance during a prophylactic examination. In this case, the person has no symptoms of the disease. In this case, you can not rush to the operation. But it is necessary to be examined from time to time in order to detect deterioration in time.
If the disease is accompanied by unpleasant symptoms (biliary colic, yellowness of the skin and mucous membranes, digestive disorders, pain in the right hypochondrium, nausea and vomiting), surgery to remove the gallbladder should be carried out as soon as possible. This will allow the patient to get rid of the painful manifestations of the disease and avoid serious complications.
How is the surgery going?
Surgical removal is performed during the remission of the disease. In this case, the patient is easier to move the intervention, the recovery process is faster. But in some cases, when the condition is life threatening, they operate in an acute condition.
There are two main methods:
- Laparoscopic surgery is less invasive because it is performed through small punctures.
- Open cholecystectomy is a classic operation that is performed through a relatively large incision in the right hypochondrium.
Laparoscopic cholecystectomy (left) and open (right)
After it, the patient remains in the clinic for postoperative observation for only 1-2 days. Full recovery and return to the usual rhythm of life takes no more than 20 days. The suture after the operation is minimal, the pain is weak. These are all – the indisputable advantages of this method, thanks to which it is easier for patients to agree to surgical treatment. This is ideal if there are no complications and contraindications.
It is undesirable to use laparoscopy if the patient has serious diseases of the heart and blood vessels. This is due to the fact that during the operation, carbon dioxide is injected to facilitate access to the site of the intervention. Increased pressure on the diaphragm, as well as the veins of the systemic circulation can provoke complications of the heart and respiratory system.
Also, laparoscopy should not be performed in acute cases, in the presence of tumors, with peritonitis and acute pancreatitis, calcification of the gallbladder.
The course of this operation worked for decades. Although recovery after it lasts longer, open surgery gives the surgeon more room for maneuver in the event that after the incision revealed complications or additional pathology. By the time it takes about the same time as laparoscopy. But if there is a tumor, it can be removed as much as possible.
If there is inflammation of the peritoneum (peritonitis), during the operation, additional sanitation can be performed to prevent blood infection.
If the operation goes without complications, after 7 days, the sutures are removed, and the patient is discharged home for 12-14 days. But at first he needs to limit physical activity. Only after 2.5 months, you can begin to do light gymnastics, which, by the way, is later necessary for the normal functioning of the digestive system.
Rehabilitation after removal of the gallbladder
Bile is directly involved in the digestive process and regulates intestinal motility. Accordingly, after its removal, these functions must be compensated. For this purpose, a whole range of methods is used: from taking medicines to therapeutic gymnastics, which will help restore intestinal motility and not gain weight.
Proper nutrition is an important component of the patient’s life after removal of the gallbladder. Since the digestive system is now functioning in a new way, you need to be even more attentive to what gets into the stomach.
It is necessary to completely eliminate heavy fatty foods, fried, strong alcohol, products without heat treatment. Raw vegetables and fruits can be consumed only by those who have constipation – and then in small quantities. Most of the diet should be vegetables that have undergone heat treatment, lean meat.
Recommendations for nutrition after cholecystectomy
After removal of the gallbladder can be used:
- light soups on low-fat broth;
- boiled, stewed or baked vegetables and fruits;
- lean chicken meat (fillet);
- soufflé and casseroles (vegetable – without a large amount of cheese);
- lean fish;
- steam cutlets made from lean meat or fish;
- fermented milk products – perfectly fresh and only if the body tolerates it well;
- cereals – only if they are thoroughly cooked;
- allowed a small amount of vegetable and butter.
You can not eat foods that provoke increased production of gastric juice: lemons and lemon juice, sour fruits. Also contraindicated:
- carbonated drinks;
- coffee and caffeinated beverages;
- pastry and pastry with cream;
- pickled and salted vegetables;
- white cabbage;
- sorrel, spinach;
- canned food (meat and fish);
- nuts and seeds, especially roasted;
All food must be chewed thoroughly. Eating such a person should be at least 5 times a day, observing approximately the same intervals and avoid periods of prolonged starvation. Portions should be small, because without the gallbladder, the digestive system is very difficult to digest large portions. Within a few months after surgery, the bile ducts dilate slightly, which provides a greater amount of bile entering the duodenum. But this is still not a complete replacement for the gallbladder.
You should not go to extremes and eat exclusively pureed food: this will slow down the work of the entire digestive system, decrease intestinal motility.
Especially strict diet should be in the first 2 months after surgery. Even lean meat, any raw fruits and vegetables are not allowed at this time: only light food that has undergone a thorough heat treatment.
If after a meal there is pain, nausea, vomiting, fever – you should consult your doctor. It is also important to remember after which products such a reaction arose.
Important point: diet after removal of the gallbladder is not a temporary phenomenon. Stick to her patient is necessary until the end of life, to prevent other serious diseases of the digestive system.
After removal of the gallbladder, it is important that the flow of bile from the hepatic ducts is timely. In case of stagnation, liver inflammation may develop. And if the operation was preceded by gallstone disease, and the patient’s bile is thick, new stones can form in the hepatic ducts.
A sharp release of a large amount of bile or its constant entry into the empty intestine leads to the formation of duodenitis (inflammation of the duodenum 12), duodenal ulcer and intestinal ulcer.
To reduce the likelihood of these complications and normalize the digestive system, after surgery, patients are prescribed choleretic and other drugs.
Medicines used after cholecystectomy:
- Enzymes. Usually, when food enters the body, bile is secreted, which in turn stimulates the production of pancreatic digestive enzymes. In people with a removed gall bladder, this process is disrupted, and often there is a lack of enzymes necessary for the breakdown of proteins, carbohydrates and fats. The additional intake of Mezim, Creon or Festala allows you to restore the balance of enzymes, normalize digestion. Especially their reception is necessary in the early stages, while the body gets used to living without the gallbladder, and the person himself determines the amount of food that can be eaten at one time without unpleasant consequences.
Patients undergoing cholecystectomy are shown taking enzymes.
Intestinal antispasmodics allow meteorism and cramping to be reduced.
Ursofalk – a drug of the group of hepatoprotectors
It is important to remember that the more carefully the patient adheres to dietary recommendations, the less ancillary drugs he needs to take.
Special therapeutic exercises will help to normalize the flow of bile from the hepatic ducts, to stimulate intestinal peristalsis. The main exercises are aimed at strengthening the anterior abdominal wall.
Many patients can do the exercises at home. But if a person has a large excess weight, especially abdominal obesity, it is better to work in a special group under the supervision of a medical instructor.
In the first days after the operation, bed rest must be observed, which means that any physical activity is excluded. After removing the stitches, you can begin to perform breathing exercises. The so-called diaphragmatic breathing (in which the muscles of the diaphragm are involved) will help restore blood circulation and prevent thrombosis, as well as maintain intestinal motility.
It does not hurt and easy warm-up joints. Firstly, it does not create a burden on the area of the operation. Secondly, while reducing the production of bile, the amount of joint lubrication decreases, which can lead to a restriction of mobility and inflammatory diseases of the joints. Light articular gymnastics will help maintain mobility and stimulate blood circulation in the joints.
A few weeks after the operation and after consulting the doctor, you can begin exercises to strengthen the abdominals. You need to start with a minimum number of repetitions, increasing the number by 1-2 a couple of times a week. If during the exercise there is pain, and then the temperature rises, you need to stop gymnastics and consult with your doctor.
Physical therapy after cholecystectomy
Walking along the stairs will also be effective. It simultaneously has a beneficial effect on the joints, intestines, helps prevent weight gain.
A few months after the operation, weighting agents, additional equipment, and skiing can be used. For a uniform load, a set of exercises (it takes 10-15 minutes) must be performed twice a day:
- in the morning on an empty stomach, before breakfast, to stimulate the production of bile;
- in the evening, one hour before bedtime, to normalize the bowels and improve the outflow of bile accumulated from the hepatic ducts per day.
Do not be limited to exercises for the press. It is necessary to start with a breathing and light warm-up, then perform several exercises for the joints (first for the arms, then for the legs), and then do the exercises to strengthen the abdominal wall.
Medical statistics says: those patients who do not ignore the gymnastics, recover faster and are much less likely to face the subsequent possible complications of cholecystectomy.
Possible complications after removal of the gallbladder
Adaptation and recovery in each case occur individually. The more a person has chronic diseases, the more difficult and longer the recovery will be. Such patients require regular check-ups by the doctor, taking auxiliary medicines and strict adherence to the diet.
Complications after surgery occur in approximately 5-10% of cases.
This diagnosis appeared in the 30s of the last century. It is associated with hypertonicity and spasm of the sphincter of Oddi, which ensures the flow of bile into the duodenum. The sphincter does not restrain bile, which is why it constantly freely enters the intestine, causing its irritation. Among the main symptoms of PHES are:
- upset stool (diarrhea);
- spasm and pain in the right hypochondrium;
Causes of postcholecystectomy syndrome
When the intestine is irritated, the sphincter of Oddi shrinks, blocking the bile duct. As a result, bile accumulates in the hepatic ducts, stagnates, provokes the development of the inflammatory process.
For the treatment of this syndrome, conservative drug therapy and a strict diet are used.
Inflammation of the duodenum develops with constant irritation of the bile, as well as digestive disorders due to lack of bile and digestive enzymes. If untreated, it can eventually transform into an ulcer. Occasionally, enteritis occurs – inflammation of the small intestine, triggered by the effects of bile and SIBO.
What is duodenitis
Duodenitis often occurs in patients with Helicobacter-associated gastritis. To avoid this complication, it is advisable to treat Helicobacter pylori before removing the gallbladder.
Excessive Bacterial Growth Syndrome
Bile – a powerful antiseptic that neutralizes infection, prevents excessive reproduction of conditionally pathogenic flora, provides antiparasitic effect. When its concentration and quantity decreases, harmful bacteria are activated in the duodenum and the small intestine following it. They cause inflammation, inhibit the beneficial microflora. In this case, it is necessary to take drugs based on bifidobacteria and lactobacilli, which will help to normalize the composition of microflora.
In the presence of chronic inflammation of the gastrointestinal tract and intestinal dysbiosis, the patient needs such drugs constantly.
Almost 80% of patients with cholelithiasis are diagnosed with pancreatitis. It remains after cholecystectomy. Sometimes this disease occurs after surgery due to a decrease in concentration and bile and a stimulating effect on the pancreas.
Causes of pancreatitis
When the ducts are blocked with stones (small stones can get into the area of the sphincter of Oddi and the pancreatic ducts with bile flow), spasm of the sphincter of Oddi causes congestion in the pancreas, which leads to its inflammation. Approximately 40% of those who have undergone cholecystectomy experience a decrease in pancreatic juice production. To solve this problem, you can use a strict diet and enzyme preparations.
It occurs on the background of serious violations in the pancreas, reducing the production of enzymes and insulin. An additional risk factor is the presence of excess weight in the patient. Therefore, after the removal of the gallbladder, it is important to control blood sugar levels in order to take action with the slightest changes and prevent the development of the disease.
Arthritis and Arthrosis
Decreasing the concentration of bile decreases the production of intra-articular lubricant. There is a mechanical erasure of cartilage. If the body has a source of chronic infection, this process is faster. Therefore, after surgery to remove the gallbladder, it is important to do gymnastics for the joints, drink more fluids, use foods rich in collagen. If there is pain, a crunch in the joint, limited mobility or swelling, you should consult with your doctor.
Cholecystectomy and pregnancy
Diseases of the gallbladder are three times more common in women than in men. Among the operated patients, women are also more. With cholecystitis and even hereditary predispositions in women during gestation, the likelihood of gallstones and overlapping of the bile ducts increases due to the increased pressure of the growing uterus on all organs of the abdominal cavity.
Surgery to remove the gallbladder in the presence of serious evidence is carried out during pregnancy. Laparoscopy is contraindicated – only open surgery is performed. In addition, the anesthesia itself, the operation and the recovery period are a shock to the woman’s body and may adversely affect the course of pregnancy. Therefore, if there is evidence, it is better to perform the operation before pregnancy.
The absence of the gallbladder is not an obstacle to the onset of pregnancy and safe carrying. But pregnant women after cholecystectomy are much more likely to experience early toxicosis. Also, digestive disorders during pregnancy occurs in almost 100% of women with a removed gallbladder.
If a woman underwent a cholecystectomy, pregnancy can be planned no earlier than 3 months after surgery – after full recovery. Throughout pregnancy, it is important to eat right and maintain physical activity.
Removal of the gallbladder is not a sentence. Subject to medical recommendations, the patient can live to a ripe old age without serious complications.